早期低分化型胃癌淋巴结转移的危险因素与腹腔镜局部切除术的探讨

霍志斌; 吴殿超; 李华; 翟同善; 栾尚峰; 穆炳阁; 王淑霞; 郭淑静

doi:10.3969/j.issn.1000-8179.2012.19.007

早期低分化型胃癌淋巴结转移的危险因素与腹腔镜局部切除术的探讨

Risk Factors of Lymph Node Metastasis and Laparoscopic Wedge Resection in Early Poorly Differentiated Gastric Cancer

摘要

摘要:
目的探讨早期低分化型胃癌淋巴结转移的危险因素, 从而对早期低分化型胃癌患者, 行腹腔镜下局部切除术提供理论依据。
方法回顾性分析80例早期低分化型胃癌的临床病理资料, 按照临床病理特征与淋巴结转移的关系进行统计学分析。
结果通过多因素分析, 肿瘤大小≥2cn, 黏膜下癌和淋巴管癌栓阳性对淋巴结转移有统计学意义(P < 0.05)。无危险因素的患者, 淋巴结转移率为0;三个危险因素都具有者, 淋巴结转移率高达42.9%。
结论肿瘤大小≥2 cm, 黏膜下癌和淋巴管癌栓阳性是早期低分化型胃癌淋巴结转移的独立危险因素对于早期低分化型胃癌患者, 行腹腔镜下局部切除术, 这三项危险因素是判断是否进行附加手术的简单标准。

Abstract:
Objective This study aimed to identify the clinicopathological factors that are predictive of lymph node metastasis (LNM) in poorly differentiated early gastric cancer(PDEGC), and to increase the possibility of using laparoscopic wedge resection for treating patients with PDEGC.
Methods Clinical data of 80 patients with PDEGC who underwent surgery were collected.The association between clinicopathological factors and LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.
Results Univariate analysis showed that the tumor size, depth of invasion, and lymphatic vessel involvement(LVI) were the significant and independent risk factors of LNM.The LNM rate reached 42.9%in cases with all three risk factors, i.e., tumor size≥2 cm, submucosal carcinoma, and positive cancer embolus of lymphatic vessels.Among all 80 patients, LNM was not found in 25 without the three clinicopathological risk factors.
Conclusion Laparoscopic wedge resection alone may be sufficient to treat intramucosal PDEGC if the tumor size is≤2.0 cm and if LVI is absent in the postoperative histological examination.

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